Integrated care one key to cutting health care costs

Dr April Schulte-Barclay of Healing Horizons Integrated Health Solutions in Grand Junction does some acupuncture on a patient.

Dr. Pramenko managing partner of Primary Care Partners.

When economists and doctors talk about the health care business, the conversation can get so dense few have the patience or background to pay attention. Most folks just want to know what can be done to make them feel better and how much it will cost.

The truth is, both conversations cover the same ground but use different words.

For example, efficiency is a word economists like to use when they talk about making health care cheaper. Efficient health care means less expensive health care, but it also means health care for the entire person — care for all of a patient’s medical needs.

In general, health care may be considered efficient when the right medical services are provided at the right time, without delay or redundancy. When this happens, people make fewer visits to the doctor and stay out of the emergency room, where the most expensive care is provided.

For the same reason, fewer people spend time in the hospital and when they do, their stay is shorter.

The result is more people enjoy better health for less cost.

According to many doctors, integrated health care is generally considered efficient health care.

At the most basic level, health care is considered integrated when several different medical service providers are connected through a reliable communication system, often under one roof.

Behavioral and mental health providers are key to this integration, particularly when health insurance companies are moving away from paying doctors based on each individual service rendered and toward a whole patient model that rewards physicians for healthier patient outcomes.

Whole care includes both physical and mental health.

Another advantage of integrating multiple practices is a reduction of the cost of a variety of business services, especially the tedious, time-consuming job of billing insurance companies, which can be shared by and thereby reduced for the individual provider.

More importantly, the practice actively supports patients in learning to manage and organize their own care at the level the patient chooses. Patients of an integrated care operation are able to obtain many of the medical services they need in one place.

“Integrated care really allows us to help patients get the proper care they need at the right place and at the right time. It streamlines a very complicated medical world for folks,” said Dr. Michael Pramenko is executive director of Primary Care Partners, 3150 N. 12th St. “A lot of times they need multiple providers, multiple services and integrated care sort of organizes that for them.”

Primary Care Partners is a Colorado Certified Medical Home, spokeswoman Paula Anderson said.

In a certified medical home, the personal physician is responsible for providing for all the patient’s health care needs. The physician takes responsibility for arranging care with other qualified professionals at all stages of life, including acute care at the hospital, chronic care for conditions like diabetes and end-of-life care like hospice, Anderson said.

At PCP, a care coordinator helps the physician make sure there’s follow-up as needed, but they also identify services already available in the community that the patient might not have been linked up with before, Pramenko said.

“You don’t need an M.D. behind your name to help folks find services that are sometimes more important than a prescription medication,” he said. “Especially in the elderly years, that includes services and support the patient receives out in the community and from family members, which is oftentimes much more important than any pill that we can put in their mouth.”

Although some medical home practices like Primary Care Partners bring together diverse teams of providers to meet the needs of their patients, smaller practices can integrate care by building virtual teams that link themselves and their patients to other providers and services in their communities.

Dr. Greg Reicks of Foresight Family Physicians, 2503 Foresight Circle, is leading the charge in that arena.

Reicks was recently named a Health IT Fellow by the Office of the National Coordinator for Health IT, an exclusive group of volunteers who promote success stories, tools and technical assistance to help providers make meaningful use of health information technology in a way that improves the delivery of patient care.

Starting in 2014, physician offices will be required to not only document patient care electronically, but use the data in a more meaningful way that actually improves patient outcomes.

There will be a lot more emphasis on communicating electronically between practices, Reicks said.

“I think there’s no question you’ve got physicians who are struggling with the change that is occurring in health care technology, care coordination, care management and other additional activities that are becoming expected as part of the standard of care,” Reicks said.

Some independent physician practices are finding it difficult to change the work flows they’ve used for 20 or 30 years, he said.

“Some physicians are frustrated and are just throwing up their hands,” Reicks said. “But others have embraced this technology. They say, ‘We’ve used it long enough now that we see the value and the benefits and we’ve gotten over that learning curve, which was steep and difficult and hard ... and realizing it can provide for more efficiency and better patient outcomes.’ ”


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